Advances for Treating in-Hospital Cardiac Arrest: Safety and Effectiveness of a New Automatic External Cardioverter-Defibrillator

OBJECTIVES: The purpose of this study was to prospectively analyze the performance and safety of a new programmable, fully automatic external cardioverter-defibrillator (AECD) in a European multicenter trial. BACKGROUND Although, the response time to cardiac arrest (CA) is a major determinant of mortality and morbidity, in-hospital strategies have not significantly changed during the last 30 years. METHODS: Patients (n = 117) at risk of CA in monitored wards (n = 51) and patients undergoing electrophysiologic testing or implantable cardioverter-defibrillator (ICD) implantation (n = 66) were enrolled. The accuracy of the automatic response of the device to any change of rhythm (lasting >1 s and >4 beats) was confirmed by reviewing the simultaneously recorded Holter data and the programmed parameters. RESULTS: During 1,240 h, 1,988 episodes of rhythm changes were documented. A total of 115 episodes lasted > or =10 s or needed treatment (pacing, n = 32; ICD, n = 51; AECD, n = 35) for termination. The device detected ventricular tachyarrhythmias with a sensitivity of 100% and specificity of 97.6% (true negatives, n = 1,454; true positives, n = 499; false positives, n = 35; false negatives, n = 0). The false positives were all caused by T-wave oversensing during ventricular pacing. There were no complications or adverse events. The mean response time was 14.4 s for those episodes needing a full charge of the capacitor. CONCLUSIONS: This new AECD is safe and effective in detecting, monitoring, and treating spontaneous arrhythmias. This fully automatic device shortens the response time to treatment, and it is likely that it will significantly improve the outcome of patients with in-hospital CA

NetCDF based data archiving system applied to ITER Fast Plant System Control prototype

EURATOM/CIEMAT and Technical University of Madrid (UPM) have been involved in the development of a FPSC [1] (Fast Plant System Control) prototype for ITER, based on PXIe (PCI eXtensions for Instrumentation). One of the main focuses of this project has been data acquisition and all the related issues, including scientific data archiving. Additionally, a new data archiving solution has been developed to demonstrate the obtainable performances and possible bottlenecks of scientific data archiving in Fast Plant System Control. The presented system implements a fault tolerant architecture over a GEthernet network where FPSC data are reliably archived on remote, while remaining accessible to be redistributed, within the duration of a pulse. The storing service is supported by a clustering solution to guaranty scalability, so that FPSC management and configuration may be simplified, and a unique view of all archived data provided. All the involved components have been integrated under EPICS [2] (Experimental Physics and Industrial Control System), implementing in each case the necessary extensions, state machines and configuration process variables. The prototyped solution is based on the NetCDF-4 [3] and [4] (Network Common Data Format) file format in order to incorporate important features, such as scientific data models support, huge size files management, platform independent codification, or single-writer/multiple-readers concurrency. In this contribution, a complete description of the above mentioned solution is presented, together with the most relevant results of the tests performed, while focusing in the benefits and limitations of the applied technologies

Magnetocardiographic localization of a non-magnetic pacing catheter

The position of a non-magnetic pacing catheter was localized non-invasively from multichannel magneto-cardiographic (MCG) measurements in five patients. A catheter specially designed to produce no magnetic disturbances was inserted in the heart after standard electrophysiological studies. Its position was recorded on cine X-ray images; thus the catheter was serving as an exactly defined current-dipole source. Magnetocardiograms were then recorded in a magnetically shielded room during cardiac pacing, and the MCG localization was performed using boundary element torso models. The MCG localizations were in good agreement with the catheter positions defined from the X-ray images; the average difference between these locations was 22\ub16 m

Study of ventricular repolarization in patients with myocardial ischemia, using unshielded multichannel magnetocardiography

Previous work, carried out in magnetically shielded rooms, has demonstrated that multichannel magnetocardiog-raphy (MMCG) is useful to detect ventricular repolarization abnormalities in patients (pts) with exercise induced myocardial ischemia. This study was aimed to evaluate the reliability of MMCG for the study of ventricular re-polarization abnormalities due to myocardial ischemia, in an unshielded hospital environment, fully equipped for intensive care, as the first step for future investigation of critical pts with acute ischemia or infarction. Quantitative analysis of rest MCG ripolarization parameters was performed according to H\ue4nninen et al. At rest magnetic field orientation of the integral of the second quarter from the J- point (ST angle \u3b1) was abnormal in 70% of the investigated patients. With present technology, MMCG can be performed also in an unshielded hospital room for intensive care, with quality good enough for non-contact monitoring and imaging of time evolution of acute myocardial ischemia

Non fluoroscopic Localization of an Amagnetic Catheter in a Realistic Torso Phantom by Magnetocardiographic and Body Surface Pace Mapping

Not availabl

Interatrial right-to-left conduction in patients with paroxysmal atrial fibrillation

We wanted to illustrate the right-to-left impulse propagation routes during sinus in patients with paroxysmal atrial fibrillation (PAF), as alterations in conduction patterns have been linked to the pathogenesis of PAF, and as no large patient materials have been published. Patients underwent 3-D electroanatomical contact mapping prior to catheter ablation. The site of the earliest left atrial (LA) activation was determined. Three different interatrial routes were identified, either as solitary pathways (36/50 patients, 72%) or in their combinations (14/50). Bachmann's bundle (BB) was involved in the majority of the cases with solitary routes (25/36). More seldom, impulse propagation occurred near the oval fossa (FO) (7/36) or the coronary sinus ostium (4/36). In patients with combined routes, both the BB (10/14) and FO routes (11/14) were included in most cases. In PAF patients, LA can be activated during sinus rhythm through three distinct connections, either encompassing a single route or via any combination of these connections. In one third, the earliest LA activation occurs outside BB. The knowledge of the propagation patterns may give insight into the pathophysiology of PAF and into refining ablation therapy